American Board of Internal Medicine (ABIM) Certification Practice Exam

What should be present to indicate a need for surgical intervention in COPD?

1. Arterial PO2 above 60 mm Hg

2. Family history of lung disease

3. Evidence of disease progression

4. Patient's age above 70 years

The correct answer is: Evidence of disease progression

The presence of evidence of disease progression in chronic obstructive pulmonary disease (COPD) is a key indicator for considering surgical intervention, such as lung volume reduction surgery or lung transplantation. As COPD advances, patients may experience worsening symptoms, decreased quality of life, increased frequency of exacerbations, and greater limitations in exercise tolerance. When there is clear evidence that a patient’s condition is deteriorating despite optimal medical management, it suggests that the standard interventions are no longer adequate to control the disease. In such cases, surgical options may provide significant benefits, especially if the patient meets other criteria for surgery. Monitoring for disease progression involves evaluating clinical features like pulmonary function tests, symptoms, and quality of life assessments. A decline in these measures may indicate that the benefits of surgical intervention could outweigh the risks, providing a potential avenue for symptom relief and functional improvement. In contrast, other factors such as an arterial PO2 above 60 mm Hg may indicate sufficient oxygenation that doesn't necessitate surgery, a family history of lung disease may not directly correlate with the need for surgical intervention, and advancing age alone does not justify surgery without the context of disease progression. Hence, the clear indication for surgical intervention aligns closely with the observed evidence of worsening disease.